Lisa writes:

<Sometimes I am reluctant to put the pump into the equation too soon, because they are seeing the drops with Manual expression, then I have them use the electric pump and nothing comes out, or 1 or 2 drops after 10 minutes of pumping, versus many drops flowing out with RPS ands manual expression, then they say to me, " I don't think I have enough", no matter that I tell them the pump is not the best reflection of what is in the Breast, I do not think they believe that. >


Thank you for your observations, Lisa. I agree, you are wise to hesitate about introducing the pump. Consider that for centuries, everyone thought that the sun traveled around the earth. Even though in school we learn scientifically that it's not true, yet we still more or less think in terms of "how high in the sky" or "how low on the horizon' etc. that the sun is.  Likewise, American women have been sucking soft drinks through straws (immersed directly into the liquid) much of their lives, believing (having "learned" kinesthetically) that it felt to them as if the suction were pulling the liquid up into their mouths. Most know what a vacuum cleaner is, and are convinced that the dirt is being "sucked up" into the bag. This impression lingers, even though many women have taken high school and college science courses and knew at one time, at least for test-taking purposes, that "Vacuum does not pull. Other forces push." 



However, in U. S. culture today, commercial advertising inundates new parents and significant others (and health care providers) with messagees about the 'efficiency' and 'necessity' of this or that brand of breast pump. It has become almost as insidious as formula advertising. Some mothers receive a pump as a baby shower gift. Knowing how vulnerable new mothers are, HCP's need to consider the potential that a pump may make matters worse in the early days, and explain these basics as part of their teaching. 



Using the idea of a common toothpaste tube makes a great teaching model. Everyone "knows" that "you have to squeeze from the back of the tube to get the most toothpaste out." So a mother can be told, truthfully, that "there is no milk in the nipple-it's in the tiny tubes deep behind the nipple. There might be some general swelling left over from your IV's, and here is a way (RPS) to "move the swelling out of the way" so that you can then "squeeze (H.E.) the little toothpaste-like  tubes."  "Squeeze" is a very powerful teaching word. It gets the message across clearly, so this is the time to emphasize gentleness, which will easily create enough hydraulic pressure on the ducts to "urge" some colostrum forward through the nipple. Itcan feel like a "sell job", but "seeing is believing".



This, of course, works best when the HCP has personally developed the skills of palpation, as well as observation. One must actually ask permission of enough moms to demonstrate, to themselves and to the moms, so as to educate their eyes and sensitize their fingertips with the "knowhow" to differentiate the feel of edema from the feel of the ducts. Once again, I emphasize how anti-gravity positioning facilitates the effectieness of RPS especially if the mother's breast is pendulous and/or very full. Of course, she then needs to roll on her side or sit up for collecting the colostrum.



It may no longer be "p.c." ('professionally' correct;-), in the lactation community at least, to refer to those ducts by the term 'lactiferous sinuses'. But as Winnie always says, "there is definitely a PWYPYF (place where you put your fingers) to express the colostrum in those ducts." Or as Jack Newman says "We won't call them that any more, but we'll keep right on acting as if they are there."  


K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC, Dayton OH 

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